Department of Surgery, Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
Department of Surgery, University of Washington Medical Center, Seattle, WA, USA.
J Gastrointest Surg. 2017 Oct;21(10):1713-1722. doi: 10.1007/s11605-017-3488-9. Epub 2017 Jul 6.
Postoperative adhesions remain one of the more challenging issues in surgical practice. Although peritoneal adhesions occur after every abdominal operation, the density, time interval to develop symptoms, and clinical presentation are highly variable with no predictable patterns. Numerous studies have investigated the pathophysiology of postoperative adhesions both in vitro and in vivo. Factors such as type and location of adhesions, as well as timing and recurrence of adhesive obstruction remain unpredictable and poorly understood. Although the majority of postoperative adhesions are clinically silent, the consequences of adhesion formation can represent a lifelong problem including chronic abdominal pain, recurrent intestinal obstruction requiring multiple hospitalizations, and infertility. Moreover, adhesive disease can become a chronic medical condition with significant morbidity and no effective therapy. Despite recent advances in surgical techniques, there is no reliable strategy to manage postoperative adhesions. We herein review the pathophysiology and clinical significance of postoperative adhesions while highlighting current techniques of prevention and treatment.
术后粘连仍然是外科实践中更具挑战性的问题之一。尽管腹膜粘连发生在每一次腹部手术后，但粘连的密度、出现症状的时间间隔和临床表现差异很大，没有可预测的模式。许多研究已经在体外和体内研究了术后粘连的病理生理学。粘连的类型和位置、粘连梗阻的时间和复发等因素仍然不可预测且了解甚少。尽管大多数术后粘连在临床上是无症状的，但粘连形成的后果可能是一个终身问题，包括慢性腹痛、需要多次住院治疗的复发性肠梗阻，以及不孕。此外，粘连性疾病可能成为一种慢性疾病，发病率高，且没有有效的治疗方法。尽管最近在手术技术方面取得了进展，但仍然没有可靠的策略来管理术后粘连。本文综述了术后粘连的病理生理学和临床意义，同时强调了目前预防和治疗的技术。
